Implant positioning devices and methods

ABSTRACT

An implant positioning device including a guide and holder for fasteners used in orthopaedic fixation for use in affixing a plate-like member to a bone or other part of a patient. The guide and holder includes a base adapted to align with the plate in a manner to orient fasteners with the plate for fixation. A plurality of fastener holders are on the base and adapted to releasably hold a fastener in a manner where the fastener is exposed at a proximal end for access by a fastener driver and aligned at a distal end with an aperture on the plate through which the fastener is to be driven.

CROSS REFERENCES TO RELATED APPLICATIONS

This application claims the benefit of U.S. Provisional PatentApplication Ser. No. 62/039,672 entitled Orthopaedic Fixation Device,filed Aug. 20, 2014, the contents of which are incorporated herein byreference in their entirety.

FIELD

The disclosure relates generally to implant positioning apparatuses anddevices. More particularly, the disclosure relates to implantpositioning apparatuses and devices for use in bone fixation, sternumfixation, and other orthopaedic fixation procedures.

BACKGROUND

In some surgical procedures involving bones, for instance, the proceduremay involve separating a bone into portions, which are thereafterreunited. This happens, for example, in entries into the chest cavity,as for heart surgery, where the sternum is required to be separatedalong its length. There may be other instances where a bone hasundergone fracturing through some trauma, and is thereafter to haveportions rejoined for proper healing. Additionally, in applicationsinvolving the spine, there may be independent bones that benefit fromholding a particular position relative to each other to allow forhealing of the disc and other surrounding tissues.

The bones or skeletal tissue, or combinations of bone and tissue, can beheld secure to one another in adjacency using a fixation device, orsystem. Many kinds of conventional fixation devices include wires orcables that are organized to pull the bone portions together, laterallyacross a divide or fracture. However, these types of fixation devicescan be relatively complex to emplace. For instance, if a plate-typestructure is to be attached to a bone, it is important to locate thefixation points (e.g., for screws) very accurately, as for drillingpilot holes for the screws. Plainly, speed and ease in then attachingthe structure are significant considerations.

SUMMARY

Implant positioning devices are disclosed for assisting in positioningorthopaedic fixation devices (such as bone plates, etc.) for use in bonefixation, sternum fixation, and other orthopaedic fixation procedures.In an embodiment, the implant positioning device includes a compressionattachment mechanism configured to removably couple to a plate. Afastener guide is coupled to the compression attachment mechanism andconfigured to receive a fastener, and a spring member is disposed in thefastener guide and configured to hold the fastener in the fastenerguide.

In another embodiment, a combined guide and holder for fasteners used inorthopaedic fixation is disclosed, wherein a plate is to be affixed to abone. In this embodiment, the device includes a base or frame adapted toalign with the plate in a manner to orient fasteners with the plate forfixation. Further, a plurality of fastener holders are on the base, witheach fastener holder adapted to releasably hold a fastener in a mannerwhere the fastener is exposed at a proximal end for access by a fastenerdriver and aligned at a distal end with an aperture in the plate throughwhich the fastener is to be driven.

In yet another embodiment, a device for positioning an orthopaedicfixation device has a base, including: a mounting structure, a firstfastener guide coupled to the mounting structure, and a second fastenerguide coupled to the mounting structure, wherein the mounting structureis between the first and second fastener guides. A compressionattachment mechanism is also coupled to the base and configured toreleasably hold a plate and align the plate with at least one of thefirst and second fastener guides.

The implant positioning device may also be used to affix fasteners to abone or other body part in a designed pattern without a plate or thelike being fixed therein.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 illustrates a first perspective view of an implant positioningdevice in accordance with an embodiment of the disclosure;

FIG. 2 illustrates a second perspective view of the implant positioningdevice of FIG. 1 in accordance with an embodiment of the disclosure;

FIG. 3 illustrates a first perspective view of a body portion of theimplant positioning device of FIG. 1 aligned with a pair of plates inaccordance with an embodiment of the disclosure;

FIG. 4 illustrates a second perspective view of the body portion of theimplant positioning device of FIG. 1 aligned with the pair of plates inaccordance with an embodiment of the disclosure;

FIG. 5 illustrates a first cut-away view of the implant positioningdevice of FIG. 1 in accordance with an embodiment of the disclosure;

FIG. 6 illustrates a third perspective view of the body portion of theimplant positioning device of FIG. 1 in accordance with an embodiment ofthe disclosure;

FIG. 7 illustrates a first cut-away view of the body portion of theimplant positioning device of FIG. 1 in accordance with an embodiment ofthe disclosure;

FIG. 8 illustrates a first cut-away view of the body portion of theimplant positioning device of FIG. 1 showing a compression attachmentmechanism in accordance with an embodiment of the disclosure;

FIG. 9 illustrates a side cut-away view of the body portion of theimplant positioning device of FIG. 1 showing the compression attachmentmechanism in accordance with an embodiment of the disclosure;

FIG. 10 illustrates a perspective view of the implant positioning deviceof FIG. 1 coupled with a plate in accordance with an embodiment of thedisclosure;

FIG. 11 illustrates a perspective view of another implant positioningdevice in accordance with an embodiment of the disclosure;

FIG. 12 illustrates a perspective view of the implant positioning deviceof FIG. 11 coupled with a plate in accordance with an embodiment of thedisclosure;

FIG. 13 illustrates a first cut-away view of the body portion of theimplant positioning device of FIG. 11 showing fasteners in accordancewith an embodiment of the disclosure;

FIG. 14 illustrates a perspective view of the compression attachmentmechanism of the implant positioning device of FIG. 11 in accordancewith an embodiment of the disclosure;

FIG. 15 illustrates a perspective view in phantom of a housing of thecompression attachment mechanism of the implant positioning device ofFIG. 11 in accordance with an embodiment of the disclosure;

FIG. 16 illustrates a perspective view of another implant positioningdevice of in accordance with an embodiment of the disclosure; and

FIG. 17 illustrates a first cut-away view of the body portion of theimplant positioning device of FIG. 16 showing fasteners in accordancewith an embodiment of the disclosure.

DETAILED DESCRIPTION

While the embodiments described hereinafter are in the environment ofpositioning devices, systems and methods for use in positioningorthopaedic fixation devices on the sternum, it should be appreciatedthat the disclosure has broader application, such as where bone or othercalcaneus body parts require fixation features, such as screws, pins, orother fastener, to be located and placed.

FIGS. 1-5 illustrate an implant positioning device 100 in the form of acombined drill guide and fixation element holder according to anembodiment of the disclosure. As illustrated, the implant positioningdevice 100 includes a frame or body portion 102, a handle portion 104coupled to the body portion 102, and a compression attachment mechanism106 including attachment feet 108 a and 108 b.

The body 102 includes one or more sets of fastener guides (for example,a first set of fastener guides 110 a and a second set of fastener guides110 b) on opposite sides of the body 102. The first set of fastenerguides 110 a includes one or more first fastener holders or fastenerhousing members 111 a capable of holding fastener captive elements 112 arespectively disposed in each of the fastener housing members 111 a.Similarly, the second set of fastener guides 110 b includes one or moresecond fastener housing members 111 b capable of holding fastenercaptive elements 112 b respectively disposed in each of the fastenerhousing members 111 b. The fastener captive elements 112 a and 112 b maybe a spring element, o-ring, etc. The first and second sets of fastenerguides 110 a and 110 b provide fastener housings 111 a and 111 b tohold, position, and guide fasteners 114 for insertion into and throughfastener apertures in one or more plates 200 (which may include a firstplate 202 a and a second plate 202 b illustrated in FIG. 3) to installthe plate(s) 200 on a bone, calcaneus body part, or other area of apatient. The plates 200 may be the plates disclosed in U.S. PatentApplication Publication No. 2015/0119887, entitled Orthopedic FixationDevice, System and Method, filed Oct. 27, 2014, the disclosure of whichis incorporated by reference herein in its entirety.

As illustrated, there are two sets of fastener guides, the first andsecond sets of fastener guides 110 a and 110 b, (one disposed on eachside of the body 102), with each set respectively including threefastener housings 111 a and 111 b, and the fasteners 114 are screws.However, there may be more or less than three fastener housings 111 aand 111 b in each set of fastener guides and the fasteners may be pins,rivets, and other types of fasteners, etc.

In this embodiment, the first and second sets of fastener guides 110 aand 110 b provide the fastener housings 111 a and 111 b in the form ofsubstantially cylindrical, hollow, tube like guide barrels that arepositioned to align with the fastener apertures in the plate(s) 200. Thefirst and second fastener housings 111 a and 111 b communicate withrespective first and second recesses 116 a and 116 b in a bottom of thebody 102. The respective first and second recesses 116 a and 116 b arerespectively sized and shaped to receive the corresponding first andsecond plates 202 a and 202 b. For example, referring to FIGS. 2-4, thefirst recess 116 a is sized and shaped to receive the first plate 202 a,and the second recess 116 b is sized and shaped to receive the secondplate 202 b. As illustrated, the first plate 202 a includes shear barsor pins 204. In this respect, the first sets of fastener guides 110 aincludes grooves 118 that communicate with the first recess 116 a. Thegrooves 118 are sized and shaped to receive the corresponding pins 204when the first plate 202 a is received in the first recess 116 a and thepins 204 are in an undeployed position (as illustrated in FIG. 4).

When in use, the first and second plates 202 a and 202 b arerespectively disposed in the corresponding first and second recesses 116a and 116 b and a bottom portion of the fastener housings 111 a and 111b are in close proximity to the plate(s) 202 a and 202 b to minimize theopportunity for any unintentional angulation of the fasteners 114 as thefasteners 114 pass through the respective guides of the first and secondsets of fastener guides 110 a and 110 b. While the first and second setsof fastener guides 110 a and 110 b are illustrated as positioned toalign with the fastener apertures of the plate(s) 200, the first andsecond sets of fastener guides 110 a and 110 b may be positioned toalign with apertures of any plate(s) or other device, and/or thelocation of the guides in each of the first and second sets of fastenerguides 110 a and 110 b may be adapted or modified to align withapertures of any plate(s) or other device. The implant positioningdevice 100 may also be used to locate and attach fasteners to a bone orother body part without any plate or the like being involved.

The first and second sets of fastener guides 110 a and 110 b may also beused to guide a driver and/or drill depending on the application. Thefirst and second sets of fastener guides 110 a and 110 b may also beused to guide other instruments, for example, to place markings, pegs,headless pins, etc. in a bone, which then serve as locating features toplace plates or any other device before or after a resection is made.

In an aspect, the first and second sets of fastener guides 110 a and 110b may be disposable, and pre-loaded with fasteners. For example, thefirst and second sets of fastener guides 110 a and 110 b may beremovable from the compression attachment mechanism 106. This allows thefirst and second sets of fastener guides 110 a and 110 b to be easilyreplaced during a surgical procedure.

As illustrated, each of the fastener housings 111 a and 111 b of thefirst and second sets of fastener guides 110 a and 110 b may include oneor more side apertures or slits. For example, each of the fastenerhousings 111 a includes first side slits or apertures 120 a, and each ofthe fastener housings 111 b includes second side slits or apertures 120b. The first and second side apertures 120 a and 120 b for one or morefinger-like structures that make up the fastener housings 111 a and 111b. These finger-like structures allow for ease of cleaning andsterilization of the implant positioning device 100. The first andsecond side apertures 120 a and 120 b may also receive and serve asexpansion zones for the fastener captive elements 112 a and 112 b,respectively.

Referring to FIGS. 1 and 5, the fastener captive elements 112 a and 112b retain a fastener 114 in the respective fastener housings 111 a and111 b of the first and second sets of fastener guides 110 a and 110 b.However, in other aspects, the fastener housings 111 a and 111 b mayhave no such side apertures 120 a/120 b and the fastener captiveelements 112 a and 112 b may be contained within the respective fastenerhousings 111 a and 111 b of the first and second sets of fastener guides110 a and 110 b. In this aspect, one or more internal recesses may beformed in the respective fastener housings 111 a and 111 b of the firstand second sets of fastener guides 110 a and 110 b to receive and serveas expansion zones for the fastener captive elements 112 a/112 b.

Referring to FIGS. 1, 3, and 5, the fastener captive elements 112 a and112 b may be spring elements that create tension against the fastener114 (for example, the threads of the fastener 114) and center thefastener 114 in the respective fastener housings 111 a and 111 b of thefirst and second sets of fastener guides 110 a and 110 b. Asillustrated, each fastener captive element 112 a, 112 b includes threespring elements or prongs 122 extending downwardly from an upper collar124. The prongs 122 extends along a side of fastener housing 111 a, 111b and includes teeth that contact and grip a side of the fastener 114(such as the threads of the fastener 114), and the collar 124 surroundsa head of the fastener 114 to hold the fastener 114 in the fastenercaptive element 112 a, 112 b. However, it should be appreciated thatmore or less than three prongs 122 may be used, and the fastener captiveelements 112 a and 112 b may be cages, or other structure.

The prongs 122 may be located at various positions around eachrespective collar 124, for example, about 120 degrees apart, when thereare three prongs 122. As illustrated, the fastener captive elements 112a, 112 b center the fasteners 114 in the respective fastener housings111 a and 111 b of the first and second sets of fastener guides 110 aand 110 b to ensure the fasteners 114 are deployed in a center of thecorresponding apertures in the corresponding plate(s) 202 a, 202 b.

The fastener captive elements 112 a, 112 b serve as a capture mechanism.For example, fastener captive elements 112 a, 112 b are biased tocompress against and apply a force to the fastener 114 and hold thefasteners 114 within each fastener housing 111 a and 111 b,respectively. Each fastener captive element 112 a and 112 b may bedisposed in and removed from the respective fastener housings 111 a and111 b of the first and second sets of fastener guides 110 a and 110 bfor ease of loading fasteners into the respective fastener housings 111a and 111 b. For example, a fastener, such as fastener 114, may bedisposed in a fastener captive element 112 b and then the fastenercaptive element 112 b along with the fastener 114 may be loaded into acorresponding fastener housing 111 b of the second set of fastenerguides 110 b. Referring to FIG. 3, each of the fastener housings 111 aand 111 b respectively include shoulders 113 a and 113 b that receiveand abut the collar 124 of the respective fastener captive elements 112a, 112 b and prevent the fastener captive elements 112 a, 112 b fromsliding or being forced into the fastener housings 111 a and 111 b whenthe fastener 114 is driven into a bone.

As a fastener 114 is driven into a bone or other material, the fastenercaptive elements 112 a/112 b may expand elastically as a head of thefastener having a larger diameter than a shank or threaded portion ofthe fastener passes through the respective fastener housings 111 a and111 b. Each of the fasteners 114 may have a head portion having afeature that mates with a driver (for example, a flat head, cross head,hex head etc. of a driver and/or drill) for use in insertion andreceiving torque to drive the fasteners 114 into a bone or other bodypart. The fastener captive elements 112 a/112 b then return to theirnormal resting state for repeated use. The fastener captive elements 112a/112 b also hold the fasteners 114 within each fastener housings 111 aand 111 b and prevent the fasteners 114 from accidentally falling out ofthe fastener housings 111 a and 111 b onto an operating room floor orinto a patient's open body cavity.

Referring to FIGS. 6-10, the body 102 includes a central mountingstructure 126 adapted to receive the compression attachment mechanism106. As illustrated in FIGS. 6-9, the central mounting structure 126couples the first and second sets of fastener guides 110 a and 110 btogether and includes a first aperture 128 extending horizontallythrough the central mounting structure 126 and a second aperture 130extending horizontally through the central mounting structure 126. Thefirst aperture 128 is proximal to a top of the central mountingstructure 126 and the second aperture 130 is proximal to a bottom of thecentral mounting structure 126. The central mounting structure 126 mayalso include a third aperture 132 extending vertically through thecentral mounting structure 126. This third aperture 132 may provide foreasy cleaning and sterilization of the implant positioning device 100.

The compression attachment mechanism 106 may be a spring loadedmechanism, that when compressed causes a distance between the attachmentfeet 108 a and 108 b to increase and when released causes the distancebetween the attachment feet 108 a and 108 b to decrease and mate withcorresponding structure on the plate(s) 200 (as illustrated in FIG. 10).The attachment feet 108 a and 108 b serve to hold two plate halves (suchas plates 202 a and 202 b) in the implant positioning device 100 at apredetermined distance from each other. As illustrated, the attachmentfeet 108 a and 108 b hold the two plate halves (such as plates 202 and202 b) in a coplanar arrangement, with the fastener apertures in theplate(s) aligned with the respective fastener housings 111 a and 111 bof the first and second sets of fastener guides 110 a and 110 b.Additionally or alternatively, the implant positioning device 100 mayhave clamping or connectable features in a plane opposite the attachmentfeet 108 a and/or 108 b, such as another set of feet oriented about 90degrees from the attachment feet 108 a and/or 108 b. These feet may alsothread into holes or attach in a number of different ways to plates andother devices.

The compression attachment mechanism 106 allows for the implantpositioning device 100 to be coupled to and uncoupled from the plates200 quickly and easily, simply by compressing the spring loadedmechanism. For example, referring to FIGS. 8-10, the compressionattachment mechanism 106 may include one or more rails, such as a firstrail 134 and a second rail 136 having corresponding gripping portions138 and 140 and first and second springs 142 and 144 disposed on acorresponding rails 134 and 136.

The first rail 134 is disposed through a first support 146 of thecompression attachment mechanism 106, through the first aperture 128 inthe central mounting structure 126, and coupled to a second support 148of the compression attachment mechanism 106. The first spring 142 isdisposed on the first rail 134 between the first support 146 and thecentral mounting structure 126. A first stop 150 may also be disposed onthe first rail 134 between the first spring 142 and the first support146. As the first gripping portion 138 is depressed in a directiontowards the second support 148, the first spring 142 is compressed andfirst rail 134 moves the second support 148, as well as the attachmentfeet 108 a away from the attachment feet 108 b.

In a similar manner, the second rail 136 is disposed through the secondsupport 148 of the compression attachment mechanism 106, through thesecond aperture 130 in the central mounting structure 126, and coupledto the first support 146 of the compression attachment mechanism 106.The second spring 144 is disposed on the second rail 136 between thesecond support 148 and the central mounting structure 126. A second stop152 may also be disposed on the second rail 136 between the secondspring 144 and the second support 148. As the second gripping portion140 is depressed in a direction towards the first support 146, thesecond spring 144 is compressed and the second rail 136 moves the firstsupport 146, as well as the attachment feet 108 b away from theattachment feet 108 a.

Thus, when the gripping portions 138 and 140 are compressed in adirection towards one another, the distance between the feet 108 a and108 b is increased. This allows the plates 200 to be placed in theimplant positioning device 100, and when the compression force appliedto the gripping portions 138 and 140 is released, the distance betweenthe feet 108 a and 108 b decreases and the feet 108 a and 108 b matewith corresponding recesses on the plate(s) 200 to couple the plate(s)200 to the implant positioning device 100 (for example as illustrated inFIG. 10). Other means and ways to hold a plate in place will also bereadily adoptable.

As illustrated in FIGS. 2, 4, and 7-10, the implant positioning device100 may also include one or more spikes 154 extending from a bottom ofthe body 102 of the implant positioning device 100 to assist in placingand holding the implant positioning device 100 and the plate(s) 200 in aproper orientation as the fasteners 114 are driven to couple theplate(s) 200 to a bone or other portion of a patient's body.

A grip may also be removably coupled to the handle 104 to provide forease of use of the implant positioning device 100. The handle 104 may beused to retain the implant positioning device 100 in a particularposition for ease of assembly of elements (such as the plates 200) thatmay be connected to it. As illustrated, the implant positioning device100 may be coupled to the plates 200 having fastener holes and variousother features. The handle 104 and grip may have an ergonomic design forcomfort and control of the implant positioning device 100. The handle104 may also be angled to accommodate soft tissues and various surgicalapproaches. Further, the handle 104 may be removable from the body 102.

In another embodiment, an implant positioning device 300 is describedwith reference to FIGS. 11-15. The implant positioning device 300 issimilar to the implant positioning device 100 described above, butincludes the modifications as described below. For example, the implantpositioning device 300 includes a body 302 and a compression attachmentmechanism 306 including attachment feet 308 a and 308 b.

The body 302 includes one or more sets of fastener guides (for example,a first set of fastener guides 310 a and a second set of fastener guides310 b) disposed on opposite sides of the body 302 and having respectivefastener captive elements 312 a and 312 b disposed in respective firstand second fastener housings 311 a and 311 b. The first and second setsof fastener guides 310 a and 310 b provide fastener housings 311 a and311 b to guide fasteners (such as fasteners 114 described above) forinsertion into fastener apertures in one or more plates (such as plates200, including the first plate 202 a and the second plate 202 b) toinstall the plate(s) on bone or other area of a patient. As illustrated,there are two sets (the first and second sets of fastener guides 310 aand 310 b, one on each side of the body 302), each having three fastenerhousings 311 a, 311 b. However, there may be more or less than threefastener housings in each of the first and second sets of fastenerguides 310 a and 310 b and the fasteners may be pins, rivets, and othertypes of fasteners, etc.

The first and second fastener housings 311 a, 311 b communicate withrespective first and second recesses 316 a and 316 b in a bottom of thebody 302. The respective first and second recesses 316 a and 316 b arerespectively sized and shaped to receive the corresponding first andsecond plates 202 a and 202 b. As described above, the first plate 202 aincludes shear bars or pins 204. In this respect, the first sets offastener guides 310 a includes grooves 318 (as illustrated in FIG. 11)that communicate with the first recess 316 a and receive thecorresponding pins 204 when the first plate 202 a is received in thefirst recess 116 a and the pins 204 are in an undeployed position.

As described above, each of the first and second fastener housings 311a, 311 b may be cylindrical hollow tube like guide barrels that arepositioned and oriented to align with the fastener apertures in theplate(s). While the first and second fastener housings 311 a and 311 bare illustrated as positioned and oriented to align with the fastenerapertures of the plate(s) 200, the first and second sets of fastenerguides 310 a and 310 b and/or the individual guide barrels may bepositioned and oriented to align with apertures of any plate or otherdevice.

As described above with reference to the implant positioning device 100,the first and second sets of fastener guides 310 a and 310 b of theimplant positioning device 300 may also be used to guide a driver and/ordrill depending on the application, and/or to guide other instruments,for example, to place markings, pegs, headless pins, etc. in a bone,which then serve as locating features to place plates or any otherdevice after a resection is made. The implant positioning devices mayalso be used simply to apply fasteners or other fixation elements alone,or in a desired pattern, as for use in a wired closure arrangement.

The first and second sets of fastener guides 310 a and 310 b may bedisposable, and pre-loaded with fasteners. For example, the first andsecond sets of fastener guides 310 a and 310 b may be removable from thecompression attachment mechanism 306. This allows the first and secondsets of fastener guides 310 a and 310 b to be easily replaced during asurgical procedure. For example, the first and second sets of fastenerguides 306 a and 306 b may be coupled around at least a portion of thecompression attachment mechanism 306 (such as a housing 356) due to theshape of the first and second sets of fastener guides 310 a and 310 band the first and second sets of fastener guides 310 a and 310 b may becoupled together by pins, for example.

As illustrated, each of the first and second fastener housings 311 a and311 b of the first and second sets of fastener guides 310 a and 310 binclude one or more side apertures or slits 320 a and 320 b,respectively, that receive and serve as expansion zones for therespective fastener captive elements 312 a and 312 b for retaining afastener in a corresponding first and second fastener housing 311 a, 311b of the first and second sets of fastener guides 310 a and 310 b.However, in other aspects, the first and second fastener housings 311 a,311 b of the first and second sets of fastener guides 310 a and 310 bmay have no such side apertures 320 a/320 b and the fastener captiveelements 312 a/312 b may be contained within the respective first andsecond fastener housings 311 a, 311 b. In this aspect, one or moreinternal recesses may be in the first and second fastener housings 311a, 311 b to receive and serve as expansion zones for the respectivefastener captive elements 312 a/312 b.

The fastener captive elements 312 a and 312 b may be spring elementsthat create tension against the fastener 114 (for example, the threadsof the fastener) and center the fastener 114 in the respective first andsecond fastener housings 311 a, 311 b. As illustrated in FIG. 13, eachfastener captive element 312 a and 312 b includes three spring elementscoupled to an upper collar. For example, each fastener captive element312 a and 312 b includes three spring elements 322 coupled to an uppercollar 324. However, it should be appreciated that more or less thanthree spring elements may be used.

Each fastener captive element 312 a and 312 b may be disposed in andremoved from the respective first and second fastener housing 311 a, 311b for ease of loading fasteners into the respective first and secondfastener housing 311 a, 311 b. For example, a fastener, such as fastener114, may be disposed in a fastener captive element 312 b and then thefastener captive element 312 b along with the fastener 114 may be loadedinto a corresponding fastener housing 311 b of the second set offastener guides 310 b.

The fastener captive elements 312 a and 312 b serve to center thefasters in the respective first and second fastener housings 311 a, 311b of the first and second sets of fastener guides 310 a and 310 b andserve also as a capture mechanism. For example, the spring elements 322compress against and apply a force to the fastener 114 and hold thefasteners 114 within each first and second fastener housings 311 a, 311b. As a fastener 114 is driven out of a first and second fastenerhousing 311 a, 311 b and into a bone or other material, the springelements 322 may expand elastically as a head of the fastener having alarger diameter than a shank or threaded portion of the fastener passesthrough the first and second fastener housing 311 a, 311 b. The springelements 322 then return to their normal resting state for repeated use.The fastener captive elements 312 a, 312 b also hold the fasteners 114within the respective first and second fastener housings 311 a, 311 b ofthe first and second sets of fastener guides 310 a and 310 b and preventthe fasteners 114 from accidentally falling out of the first and secondfastener housings 311 a, 311 b onto an operating room floor or into apatient's open body cavity.

The compression attachment mechanism 306 may include a spring loadedmechanism that when compressed causes a distance between the attachmentfeet 308 a and 308 b to increase and when released causes the distancebetween the attachment feet 308 a and 308 b to decrease and mate withcorresponding structure (such a mating recesses) in the plate(s) 200.The attachment feet 308 a and 308 b serve to hold the two plate halves202 a and 202 b in the implant positioning device 300 at a predetermineddistance from each other. As described above, the attachment feet 308 aand 308 b hold the plate halve(s) 202 a and 202 b in a coplanararrangement, with the fastener apertures in the plate(s) 202 a and 202 baligned with the respective guide barrels of the first and second setsof fastener guides 310 a and 310 b.

The compression attachment mechanism 306 allows for the implantpositioning device 300 to be coupled to and uncoupled from the plate(s)quickly and easily, simply by compressing the spring loaded mechanism.For example, referring to FIGS. 11-15, the compression attachmentmechanism 306 may include a housing 356, one or more rails 334 and 336having corresponding gripping portions 338 and 340 and springs 342 (notshown) and 344 disposed on a corresponding rail 334 or 336. It should beappreciated that the housing 356 is illustrated in FIGS. 14-15 astransparent to allow an internal structure of the compression attachmentmechanism 306 to be visible.

Referring to FIG. 14, the compression attachment mechanism 306 includestwo rails, a top or first rail 334 and a bottom or second rail 336 belowthe first rail 334. The first rail 334 is disposed through a firstsupport 346 and coupled to a second support 348, and the second rail 336is disposed through the second support 348 and coupled to the firstsupport 346. The housing 356 is disposed around the rails between thefirst support 346 and the second support 348.

Referring to FIGS. 14 and 15, the housing 356 includes a firstlongitudinal channel 358 adapted to receive the first rail 334 and asecond longitudinal channel 360 adapted to receive the second rail 336.The first longitudinal channel 358 extends from a first opening 362having a first diameter to a stop 364 internal to the housing 356, atwhich the first longitudinal channel 358 transitions to a seconddiameter smaller than the first diameter and continues to extend fromthe stop 364 to a second opening 366. Similarly, the second longitudinalchannel 360 extends from a first opening 368 having a first diameter toa stop 370 internal to the housing 356, at which the second longitudinalchannel 360 transitions to a second diameter smaller than the firstdiameter and continues to extend from the stop 370 to a second opening372. As illustrated, the first opening 362 with the first diameter ofthe first longitudinal channel 358 is proximal to a first end of thehousing 356, and the first opening 368 with the first diameter of thesecond longitudinal channel 360 is proximal to a second end of thehousing 356 opposite the first end.

A spring is disposed around each of the rails 334 and 336, andpositioned in the respective areas of the housing having the firstdiameter. As illustrated, only the spring 344 is illustrated as disposedaround the second rail 336 and disposed in the first diameter of thesecond longitudinal channel 360. It should be appreciated that a similarspring is also disposed around the first rail 334 and disposed in thefirst diameter of the first longitudinal channel 358.

The spring 344 applies a spring bias force against the stop 370 wherethe transition of the first and second diameters is located in adirection of the gripping portion 140 of the second rail 336. Similarly,the spring of the first rail 334 applies a spring bias force against thestop 364 where the transition of the first and second diameters islocated in a direction of the gripping portion 338 of the first rail334. When the gripping portions 338 and 340 are compressed in adirection towards the housing 356 or one another, the distance betweenthe feet 308 a and 308 b is increased. This allows the implantpositioning device 300 to be placed over the plate(s) 200, and when thecompression force applied to the gripping portions 330 a and 340 isreleased, the distance between the feet 308 a and 308 b decreases andthe feet 308 a and 308 b mate with the recesses on the plate(s) 200 tocouple the plate(s) 200 to the implant positioning device.

As illustrated in FIGS. 12 and 13, the implant positioning device 300may also include one or more spikes 354 extending from a bottom of theimplant positioning device 300 to assist in placing and holding theimplant positioning device 300 and the plate(s) 200 in a properorientation as the fasteners 114 are driven to couple the plate(s) 200to a bone or other portion of a patient's body.

In yet another embodiment, an implant positioning device 400 isdescribed with reference to FIGS. 16 and 17. The implant positioningdevice 400 is similar to the implant positioning devices 100 and 300described above, but includes the modifications as described below. Forexample, the implant positioning device 400 includes a body 402, ahandle 404 coupled to the body 402, and a compression attachmentmechanism 406 including attachment feet 408 a and 408 b.

The body 402 includes one or more sets of fastener guides (for example,a first set of fastener guides 410 a and a second set of fastener guides410 b) disposed on opposite sides of the body 402 and having respectivefirst and second fastener housings 411 a and 411 b that receivecorresponding fastener captive elements 412 a and 412 b.

The first and second sets of fastener guides 410 a and 410 b providefastener housings 411 a and 411 b to hold and guide fasteners 114 forinsertion into and through fastener apertures in one or more plates 500(including first and second plates 502 a and 502 b) to install theplate(s) on a bone or other area of a patient. As illustrated, there aretwo sets, the first and second sets of fastener guides 410 a and 410 b,(one disposed on each side of the body 402), with each set includingfour fastener housings 411 a, 411 b. However, there may be more or lessthan four fastener housings in each set of fastener guides and thefasteners may be pins, rivets, and other types of fasteners, etc.

In this embodiment, the first and second sets of fastener guides 410 aand 410 b provide fastener housings 411 a and 411 b in the form ofsubstantially cylindrical, hollow, tube like guide barrels that arepositioned to align with the fastener apertures in the plate(s). Whilethe first and second sets of fastener guides 410 a and 410 b areillustrated as positioned to align with the fastener apertures of theplate(s) 502 a and 502 b, the first and second sets of fastener guides410 a and 410 b may be positioned to align with apertures of anyplate(s) or other device, and/or the location of the guides in each ofthe first and second sets of fastener guides 410 a and 410 b may beadapted or modified to align with apertures of any plate(s) or otherdevice.

As described above, the first and second sets of fastener guides 410 aand 410 b may also be used to guide a driver, drill, or instrumentdepending on the application, for example, to place markings, pegs,headless pins, etc. in a bone, which then serve as locating features toplace plates or any other device before or after a resection is made.

In an aspect, the individual fastener housings 411 a and 411 b of thefirst and second sets of fastener guides 410 a and 410 b may be adaptedto swivel to allow for varying degrees of angular positions for guidingthe fasteners 114. In another aspect, the individual fastener housings411 a and 411 b of the first and second sets of fastener guides 410 aand 410 b may individually be slidable along a shaft or bar to allow theposition of each respective fastener housings 411 a, 411 b to beadjusted. A length and diameter of the individual fastener housings 411a and 411 b of the first and second sets of fastener guides 410 a and410 b may also be varied to accommodate different lengths of fastenersand fasteners of different diameters.

In an aspect, the first and second sets of fastener guides 410 a and 410b may be disposable, and pre-loaded with fasteners. This allows thefirst and second sets of fastener guides 410 a and 410 b to be easilyreplaced during a surgical procedure. For example, the first and secondsets of fastener guides 410 a and 410 b may be coupled to thecompression attachment mechanism 406 by a compression locking mechanism474 (which is illustrated as a turn knob). Removal of the compressionlocking mechanism 474 allows the first and second sets of fastenerguides 410 a and 410 b to be removed from the compression attachmentmechanism 406.

As illustrated, each of the fastener housings 411 a and 411 b of thefirst and second sets of fastener guides 410 a and 410 b include one ormore side apertures, such as first side apertures 420 a and second sideapertures 420 b. The first and second side apertures 420 a and 420 breceive and serve as expansion zones for the fastener captive elements412 a and 412 b, respectively. The fastener captive elements 412 a and412 b retain a fastener 114 in the respective fastener housing 411 a,411 b of the first and second sets of fastener guides 410 a and 410 b.However, in other aspects, the fastener housings 411 a and 411 b mayhave no such side apertures 420 a/420 b and the fastener captiveelements 412 a and 412 b may be contained within the respective fastenerhousing 411 a and 411 b. In this aspect, one or more internal recessesmay be formed in the respective fastener housings 411 a and 411 b toreceive and serve as expansion zones for the fastener captive elements412 a/412 b.

The fastener captive elements 412 a and 412 b may be spring elementsthat create tension against the fastener 114 (for example, the threadsof the fastener) and center the fastener 114 in the respective fastenerhousings 411 a and 411 b. As illustrated, there are three fastenercaptive elements 412 a in each respective fastener housing 411 a of thefirst set of fastener guides 410 a, and three fastener captive elements412 b in each respective fastener housing 411 b of the second set offastener guides 410 b. However, it should be appreciated that more orless than three may be used.

The fastener captive elements 412 a, 412 b may be located at variouspositions around each respective fastener housings 411 a and 411 b, forexample, about 120 degrees apart, when there are three fastener captiveelements 412 a, 412 b per fastener housing 411 a, 411 b. As illustrated,the fastener captive elements 412 a, 412 b center the fasteners 114 toensure the fasteners 114 are deployed in a center of the correspondingapertures in the plate(s) 502 a, 502 b.

The fastener captive elements 412 a, 412 b also serve as a capturemechanism. For example, as a fastener 114 is driven into a bone or othermaterial, the fastener captive elements 412 a, 412 b may expandelastically as a head of the fastener having a larger diameter than ashank or threaded portion of the fastener passes through the respectivefastener housing 411 a, 411 b. The fastener captive elements 412 a, 412b then return to their normal resting state for repeated use. Thefastener captive elements 412 a, 412 b also hold the fasteners 114within each fastener housing 411 a, 411 b and prevent the fasteners 114from accidentally falling out of the fastener housings 411 a, 411 b ontoan operating room floor or into a patient's open body cavity.

The compression attachment mechanism 406 (which is similar inconstruction to the compression attachment mechanism 106 and/or 306described above) may include a spring loaded mechanism, disposed in thehousing 456, that when compressed causes a distance between theattachment feet 408 a and 408 b to increase and when released causes thedistance between the attachment feet 408 a and 408 b to decrease andmate with corresponding structure on the plate(s). As illustrated, theattachment feet 408 a and 408 b hold the two plate halves 502 a and 502b in a coplanar arrangement, with the fastener apertures in the platesaligned with the respective sets of fastener guides 410 a/410 b. Thecompression attachment mechanism 406 allows for the implant positioningdevice 400 to be coupled to and uncoupled from the plates 502 a and 502b quickly and easily, simply by compressing the spring loaded mechanism.

The implant positioning device 400 may also be adapted to accommodatedifferent plate geometries. Additionally, the implant positioning device400 may also have clamping or connectable features in a plane oppositethe attachment feet 408 a and 408 b, such as another set of feetoriented about 90 degrees from the attachment feet 408 a and 408 b.These feet may also thread into holes or attach in a number of differentways to plates and other devices.

The compression locking mechanism 474, as illustrated, is a threadedturn knob disposed on a top of the implant positioning device 400. Thecompression locking mechanism 474 may be tightened, for example, byturning the compression locking mechanism 474, to place a compressionforce against an inner rail of the compression attachment mechanism 406to lock the compression attachment mechanism 406 in a desired position.While the compression locking mechanism 474 is illustrated as a threadedturn knob, the compression locking mechanism 474 may be any number oflocking mechanisms, for example, one or more levers, cams, etc. that areconfigured to lock the compression attachment mechanism 406 in a desiredposition. These mechanisms may also be designed such that a user canonly place fasteners 114 into the guide barrels of the first and secondsets of fastener guides 410 a and 410 b when the implant positioningdevice 400 is in a locked position. In this aspect, the lockingmechanism may cover the guide barrels of the first and second sets offastener guides 410 a and 410 b in an unlocked position.

The handle 404 may be removably coupled to the implant positioningdevice 400 and is used to retain the implant positioning device 400 in aparticular position for ease of assembly of elements (such as the plates502 and 502 b) that may be connected to it. The handle 404 may alsoinclude a grip 476 with an ergonomic design for comfort and control ofthe implant positioning device 400.

The implant positioning devices 100, 300 and/or 400 may be adapted ormodified to accommodate different plate geometries. Additionally, one ormore features of the implant positioning devices 100, 300 and/or 400 maybe incorporated into the other implant positioning devices 100, 300and/or 400. For example, the implant positioning device 300 may includethe locking mechanism and the handle described in connection with theimplant positioning device 400. Similarly, the fastener housings of thefirst and second sets of fastener guides 110 a and 110 b/310 a and 310 bmay be adapted to swivel to allow for varying degrees of angularpositions for guiding the fasteners 114. The fastener housings of thefirst and second sets of fastener guides 110 a and 110 b/310 a and 310 bmay individually be slidable along a shaft or bar to allow the positionof each respective fastener housing of the first and second sets offastener guides 110 a and 110 b/310 a and 310 b to be adjusted. Further,a length and diameter of the fastener housings of the first and secondsets of fastener guides 110 a and 110 b/310 a and 310 b may also bevaried to accommodate different lengths of fasteners and fasteners ofdifferent diameters.

The locking mechanism incorporated into the implant positioning devices400 may be the turn knob described above, or may be another type oflocking mechanism. For example, the locking mechanism may be a rack andpinion, ratchet, lever, a switch, or other type of locking mechanismknown in the art.

The implant positioning devices 100, 300 and/or 400 may be used inconjunction with any device that utilizes screws, drills, pins, and/orother types of fasteners or drilling device that involve directionalalignment, positioning, etc. prior to final fixation. For example, theimplant positioning devices 100, 300 and/or 400 may be used to guide adrill bit and then also be used to place a screw or other fastener.

The implant positioning devices 100, 300 and/or 400 may be used inconjunction with any type of bone plate or other type of plate. Forexample, the implant positioning devices 100, 300 and/or 400 may be forused for fixation of boney elements to prevent motion in a particulardirection as well as providing dynamic stabilization.

The sets of fastener guides, for example, the first and second sets offastener guides 110 a and 110 b/310 a and 310 b may have a base profileproximal to the plate(s) 200 that is extended as compared to the implantpositioning device 400, to conform to a shape of the plate(s) 500. Thisserves as a loading tool for the plate(s) 200 and/or 500. For example,the base profile of the first and second sets of fastener guides may bekeyed so left and right are not commingled. The base profile of thefirst and second sets of fastener guides may also provide stabilizationwhen the fasteners are driven into the bone or other part of a patient'sbody to prevent torqueing of the plate/device. Thus, it preserves theorientation of each plate respectively to the other.

The implant positioning devices 100, 300 and/or 400 may be used to fixplates or other implant devices, as well as remove such devices. Forexample, the implant positioning devices 100, 300 and/or 400 may be usedfor screw or fastener removal. In this aspect, the fastener(s) may bepulled into the guide barrels of the first and second sets of fastenerguides and held by the fastener captive elements to prevent thefasteners from falling into the patient.

The sets of fastener guide may also be wholly or partially transparentto allow the user to view the progress of the fastener beinginserted/driven. The sets of fastener guides may also each include oneor more fastener housings to accommodate or be agnostic to varyingplate(s) and other devices with a single or more than one fasteneraperture. The sets of fastener guides may also be adjustable, toaccommodate shorter, wider, longer, etc. plate(s) and other devices ofthe type.

Although the devices, systems, and methods have been described andillustrated in connection with certain embodiments, many variations andmodifications should be evident to those skilled in the art and may bemade without departing from the spirit and scope of the disclosure. Thedisclosure is thus not to be limited to the precise details ofmethodology or construction set forth above as such variations andmodification are intended to be included within the scope of thedisclosure.

What is claimed is:
 1. A device for positioning an orthopaedic fixationdevice, comprising: a compression attachment mechanism configured toremovably couple to a plate; a fastener guide coupled to the compressionattachment mechanism and configured to receive a fastener; and a springmember disposed in the fastener guide and configured to hold thefastener in the fastener guide.
 2. The device of claim 1, wherein thecompression attachment mechanism includes attachment feet adapted toremovably couple the plate to the compression attachment mechanism inalignment with the fastener guide.
 3. The device of claim 1, wherein thespring member includes a collar and one or more prongs extendingdownwardly from the collar.
 4. The device of claim 3, wherein the springmember includes three prongs extending downwardly from the collar. 5.The device of claim 1, wherein the fastener guide includes a firstfastener guide and a second fastener guide disposed on opposing sides ofthe compression attachment mechanism.
 6. The device of claim 5, whereineach of the first fastener guide and the second fastener guide include aplurality of fastener housings configured to receive individualfasteners.
 7. The device of claim 1, wherein the compression attachmentmechanism includes: first and second supports; a first rail extendingthrough the first support, through a first aperture in a mountingstructure of the fastener guide, and coupled to the second support; afirst spring is disposed on the first rail between the first support andthe mounting structure; a first stop disposed on the first rail betweenthe first spring and the first support; and a first gripping portioncoupled to the first rail proximal to the first support.
 8. The deviceof claim 1, wherein the spring is configured to compress between thefirst stop and the mounting structure upon application of a force in adirection towards the second support.
 9. A combined guide and holder forfasteners used in orthopaedic fixation, wherein a plate is to be affixedto a bone, comprising: a base adapted to align with the plate in amanner to orient fasteners with the plate for fixation; a plurality offastener holders on the base, each fastener holder adapted to releasablyhold a fastener in a manner where the fastener is exposed at a proximalend for access by a fastener driver and aligned at a distal end with anaperture in the plate through which the fastener is to be driven. 10.The device of claim 9, wherein the plurality of fastener holders aretubular.
 11. The device of claim 10, further comprising a biasingelement extending inboard from a tubular sidewall holding an individualfastener in an individual fastener holder.
 12. The device of claim 11,wherein multiple biasing elements are spaced about the tubular sidewallto center the individual fastener.
 13. The device of claim 9, furthercomprising a compression attachment mechanism configured to releasablycouple the plate to the base.
 14. The device of claim 9, wherein thebase includes a recess sized and shaped to receive the plate.
 15. Adevice for positioning an orthopaedic fixation device, comprising: abase, including: a mounting structure; a first fastener guide coupled tothe mounting structure; and a second fastener guide coupled to themounting structure, wherein the mounting structure is between the firstand second fastener guides; and a compression attachment mechanismcoupled to the base and configured to releasably hold a plate and alignthe plate with at least one of the first and second fastener guides. 16.The device of claim 15, wherein each of the first and second fastenerguides include a fastener housing configured to receive a fastener. 17.The device of claim 16, further comprising a spring member disposed inthe fastener housing and configured to hold the fastener in the fastenerguide.
 18. The device of claim 15, wherein each of the first and secondfastener guides include a bottom recess sized and shaped to receive theplate.
 19. The device of claim 18, wherein the compression attachmentmechanism releasably holds the plate in the recess.
 20. The device ofclaim 15, wherein the base further includes a spike extending from abottom of the base to assist in placing and holding the device in aproper orientation.
 21. A device for applying a plurality of fastenerelements to the exterior of a bone or other calcaneus body part,comprising: a frame adapted to be placed on or adjacent a bone, and aplurality of fastener holders on the frame, each of which releasablyhold and position a fastener element therein for attachment to the boneusing an implement driving the fastener element through the holder intothe bone.
 22. The device of claim 21, wherein the fastener holders havea holder part associated therewith which embraces and holds the fastenerelement within the respective fastener holder.
 23. The device of claim22, wherein the holder part is a resilient member contacting thefastener element.
 24. The device of claim 23, wherein the resilientmember comprises a prong extending along a side of the respectivefastener holder which is biased to engage a side of the fastenerelement.
 25. The device of claim 22, wherein each of the fastenerholders are a tubular construct formed on the frame, and the holder partis separate from the tubular construct and surrounds at least a portionof the fastener element, the holder part being received or loaded intothe tubular construct in use.
 26. The device of claim 25, wherein theholder part includes a resilient member contacting the fastener element.27. The device of claim 26, wherein the resilient member comprises atleast one prong extending along a side of the respective fastener holderwhich is biased to engage a side of the fastener element.
 28. The deviceof claim 25, wherein the holder part is a cage surrounding at least aportion of the fastener element.